Having Your Menu Assessed by the Healthy Together Healthy Eating Advisory Service Will

Menu assessment
booking form
Healthy Eating Advisory Service
Schools

Having your menu assessed by the Healthy Together Healthy Eating Advisory Service will enable you to receive feedback based on the Victorian Department of Education and Early Childhood Development’s School Canteens and Other School Food Services Policy. You will be provided with ideas to assist in ‘greening’ up your menu, along with helpful tips to promote the healthier choices.

This assessment is free of charge for any food service offered in a Victorian primary or secondary school, whether it is an on-site canteen or external caterer, such as a milk bar.

Completion of a menu assessment by the Healthy Eating Advisory Service will assist your school in working towards the Healthy Eating and Oral Health benchmarks for the Healthy Together Achievement Program. Further information about the Achievement Program can be found at

Please complete the following form and submit with a copy of your menu(s) and any other relevant information, such as recipes and items sold in the canteens that are not featured on the menu. Please contact the Healthy Eating Advisory Service if you require assistance in completing this form. Allow up to four weeks for feedback.

Submit to:

Mail: Nutrition Australia Victorian Division, 118 Cardigan Street, Carlton VIC 3053

Fax: (03) 9348 0178

Email:

If you have any queries, contact the Healthy Eating Advisory Service on 1300 22 52 88.

Step 1: Your details

School/Business Name: ______

Contact name:______Position: ______

E-mail:______Phone: ______

Postal address:______ Postcode: ______

Menu assessment booking form1

Type of food service:

 On-site canteen (run by school) /  Milk bar
 On-site canteen (outsourced) /  Other (please specify)

Menus provided for assessment:

 Summer menu /  Hot food rotating menus
 Winter menu /  Other (please specify): ______

Step 2: List details of food and drink products

Please provide as much information as possible on all items sold to allow for accurate and detailed feedback. This includes brands and sizes for commercial products and details on homemade recipes. If any extra space is needed, please add additional page(s).

Hot foods

Commercial products:

Please list product details, such as brand names, information on the product range, and serving size.

Eg / Brand: Mrs Mac’s / Product Name: Good Eating Range Sausage Roll / Serving size: 120g

Pies: Brand: ______Product name: ______Serving size: ______

Brand: ______Product name: ______Serving size: ______

Pastries:Brand: ______Product name: ______Serving size: ______

Sausage rolls:Brand: ______Product name: ______Serving size: ______

Pizza:Brand: ______Product name: ______Serving size: ______

Fried rice:Brand: ______Product name: ______Serving size: ______

Hot dog:Brand: ______Product name: ______

Dim sim:Brand: ______Product name: ______

Chicken nuggets:Brand: ______Product name: ______

Chicken strips/tender:Brand: ______Product name: ______

List deep fried products:

Brand / Product name / Serving size

Other hot commercial items:

Brand / Product name / Serving size

Recipes for homemade hot items:

Where possible, please include a copy of the recipes used including the quantities of all ingredients and number of serves. Otherwise provide detailed information about the ingredients used, e.g. regular or reduced fat cheese, sour cream etc.

e.g. Homemade pizza, per pizza – 1 large wholemeal pita bread, 1 cup low fat Bega cheese, 1 cup low fat ham, 1 cup tinned pineapple.

Sandwiches/wraps/rolls

Bread: white  wholemeal other:______

Ham: regular  reduced salt

Chicken:  commerciallyroasted – served with skin commerciallyroasted – served with no skin

home cooked chicken schnitzel  deep fried  oven baked/grilled

free flow chicken: brand ______chicken loaf/roll: brand ______

Other meat items: (e.g. tuna, salami, strass etc)

Brand / Product name / Serving size

Cheese: Brand ______regular reduced fat

Other cheese: ______

Spreads: butter margarine dairy blend

Mayonnaise: Brand______regular reduced fat

Other sandwich fillings used:

Snacks

Please list details of commercial snacks

Chips/savoury snack foods: Brand: ______Product name: ______Serving size: ____

Brand: ______Product name: ______Serving size: ____

Popcorn: Brand: ______Product name: ______Serving size: ____

Muesli bars: Brand: ______Product name: ______Serving size: ____

Muffins: Brand: ______Product name: ______Serving size: ____

Cakes/slices: Brand: ______Product name: ______Serving size: ____

Sweet biscuits: Brand: ______Product name: ______Serving size: ____

Biscuits and cheese: Brand: ______Serving size: ______Cheese:regularreduced fat

Yoghurt: Brand: ______Product name: ______regularreduced fat

Dairy desserts, e.g. custard: Brand: ______Product name: ______

Confectionery: (All types) ______

______

Other commercial snack items: ______

Recipes for homemade snacks:

Where possible, please include a copy of the recipes used, including the quantities of all ingredients and number of serves. Otherwise provide detailed information about the ingredients used, e.g. regular or reduced fat cheese, wholemeal flour etc.

e.g. Homemade muffins – ½ cup white flour/wholemeal flour, 1 tbsp cocoa, 1 egg, ¼ cup sugar, 1 tbsp margarine

Frozen items

Brand / Product name / Serving size
e.g. Quelch / Fruit sticks (100% fruit juice) / 20g

Drinks

Flavoured milk: Brand: ______Varieties: ______

Serving size: ______full fat reduced fat

Plain milk: Brand: ______Serving size: ______full fat reduced fat

Juice: Brand: ______Varieties: ______

Serving size: ______99% juice less than 99% juice

 Tea full fat milk reduced fat milk

 Coffee full fat milk reduced/ fat milk

Hot chocolate: Brand: ______full fat reduced fat

Milkshake/smoothie ingredients:(Tick if using the following ingredients)

regular milk reduced fat milk regular yoghurt  reduced fat yoghurt  regular ice-cream

reduced fat ice-cream

Flavouring: e.g. Strawberry syrup/topping ______

 fruit Serving sizes: Small ______mL Large ______mL

Otheringredients: ______

Please list all other drinks, including flavours and sizes: (includes fizzy drinks)

Brand / Product name / Serving size
Brand / Brand product name/flavour / Serving size
Eg. Focus– raspberry 350ml / Sports Water - raspberry / 350ml

Privacy

Nutrition Australia Victorian Division will maintain the confidentiality of information you provide while working with the Healthy Eating Advisory Service to improve your menu. Your information will not be shared in a public domain without your permission. However, we may disclose information to health professionals or program partners for the purpose of providing you with support. We may also provide non-identifying information to other parties for reporting, research or evaluation purposes. We will take all reasonable steps to protect the privacy of your personal information. If you want to access or change any of the information you have supplied, please phone us on 1300 22 52 88.

To receive this document in an accessible format phone 1300 22 52 88 or email

Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services.

Menu assessment booking form1